Robert Elliott University of Strathclyde

Five years ago: Invited to join the Counselling Unit Walked into a place with a deep sense of culture and history built up over many years But also, deeply counter-cultural Complex web of: Courses and projects Relationships and traditions Large team of talented trainers and counsellors Highly committed students, past and present

Fear & trembling: Questions raised: Would I be able to do meaningful work in this new setting? Would I be accepted? Is there space for my way of working with clients here? Would I change it? Would it change me?

What is the relationship between Process-Experiential/Emotion-Focused Therapy And the Person-Centred Approach? In the early 1990’s, Barbara Brodley and John Shlien had both said to me: (Process)-Experiential therapy, Focusing, Emotion- Focused Therapy ≠ Person-centred But Laura Rice, Les Greenberg & I had all started from a Person-Centred base Felt we were Person-Centred So, coming here, I began…

With colleagues: Classical/nondirective Person-Centred Therapy (PCT) Broadly relational PCT Pluralistic My position has varied: Curiosity & puzzlement Awe & scepticism Frustration & excitement Will present what I’ve learned so far from this dialogue Past, Present & Future

Roots/Sources: Humanism (The Renaissance, The Enlightenment, existentialism, Third force Humanistic psychology) 1940’s: Nondirective therapy: Rogers 1950’s: Classical approach: Chicago Relationship conditions: unconditional positive regard, empathy, genuineness 1960’s: Focus on client process: Wisconsin Late Rogers, Gendlin The dialogue begins…

1970’s: Experiential therapy: Gendlin: Focusing Rice, Greenberg: task analysis 1980’s: Partial eclipse period Dismissed in North America Further development of PCA in Europe 1990’s: Beginning of PCE revival Training centres established: Counselling Unit Process-Experiential (PE)/Emotion-Focused Therapy (EFT) Explosion of research

2000’s: World Association founded Journal: Person-Centered and Experiential Psychotherapies Struggles for recognition Research continues rapid development EFT books & training emerge

Continuing dialogue between different parts of the tradition, especially from 1970 on One end: “Classical” approaches Emphasize Nondirectivity, Unconditional Positive Regard, the centrality of the relationship Other end: Emotion-Focused Therapy Emphasize client process, process guiding, the work of therapy “Pluralistic Approach” fits in there somewhere…

Counselling Unit: One of few places in the world where it would have been possible to carry out this dialogue Over an extended period of time And with reference to actual practice Most importantly, this has allowed exploration of the deeper issues of personal and professional identity: Need to hang onto what is essential vs. need to escape oppressive restrictions Need to establish self vs. feeling threatened or excluded Which takes us to …

As a result of recent history of dialogue over our differences, can now ask: Have PCT vs EFT differences been exaggerated? Two recent efforts to look at this…

EFT jargon can put PCT therapists off Makes it sound like EFT therapists are pulling levers and controlling clients Have been trying to translate into PCT Friendly language Many discussions with Beth Freire, Brian Rodgers, Graham Westwell, and others Example: The Six EFT Therapy Principles

Research Clinic therapists examined the 6 EFT principles. Decided the following 3 need no translation: 1. Empathic Attunement: Always start by entering, attending to & tracking the client’s immediate experiencing 2. Therapeutic Bond: Offer genuine, empathic, caring presence to client 3. Self-development: Foster client growth, empowerment & choice

Involve different kinds of therapeutic work (=“tasks”) 4. “Task Collaboration”: Listen for and engage with what client wants to work on Offer orienting information about nature of therapy and particular ways of working in the session, particularly when the client asks or is puzzled

5. “Task Completion/Emotional Change”: Listen for and engage with key issues clearly or repeatedly presented by client Help client contact, explore and clarify core, growth-oriented emotions and views of self/others Keep helping client work on their key issues until they feel they have resolved these or decide they want to stop … and the client decides what is key, core, or resolved

6. “Process Guiding”: Be aware of and respond helpfully to common kinds of client experiences and process Eg, Empathic Refocusing response: allow C to step back from difficult emotions before offering opportunity to return to them Respond to client-presented issues by offering opportunities for potentially useful kinds of therapeutic work Always accept client’s decision about whether or not to accept a process offer

Freire, Elliott & Westwell, 2011 Developed quantitative process rating measure of PCE therapist adherence/competence Person-Centred and Experiential Psychotherapy Scale (PCEPS) Two subscales: Person-Centred (PC): 10 items Eg Client frame of reference; content nondirectiveness Experiential Process (Exp): 5 items Eg Experiential specificity, emotion focus 1 – 6 descriptively-anchored scales Passing = 3.5+

Just finished test of measure on 120 segments: Research Clinic data min segments 60 sessions, 20 clients, 10 therapists 5 student therapists (general client sample) 5 post-training therapists (clients with social anxiety) 2 PCT, 3 EFT (2 fully trained)

1. PCEPS is reliable (across items and raters) 2. In general, PC and Exp items correlate very highly with each other 3. We also found a Nondirectiveness factor Empowering Presence, Content Nondirectiveness, Clarity/brevity 4. Student therapists scored lower on all items 5. No difference between fully trained PCT and EFT therapists on: PC, Exp, and nondirectiveness subscales Conclusion: Therapist and training effects much more important than PCT vs EFT differences

N Seg- ments Mean score % “passing” (at least 3.5) Range Student therapists 603.1*17%0 – 33% PCT therapists %83-100% EFT therapists %33-100% EFT fully trained %92-100% *P<.001 vs. SA protocol therapists (PCT + EFT); all other effects nonsignificant

PC Scale: Mean PC Scale: % pass Exp Scale: Mean Exp Scale: % pass NDir Scale Mean Ndir Scale % pass PCT therapists 4.592%4.296%4.687% EFT therapists 4.278%4.275%4.0*72% EFT fully trained 4.696%4.796%4.483% *P<.01 vs. PCT therapists; all other effects nonsignificant

Where does this leave us? Some concluding thoughts about avenues for continuing the dialogue Provides an agenda for the future

Is it worth continuing to argue at an ideological level over nondirectivity and process guiding? Like Psychology, we have been neglecting study of concrete behavior in favor of the ease of self- report data Both quantitative questionnaires & qualitative interviews PCEPS study illustrates value of following the example of early Carl Rogers and colleagues We need to return to the study of therapy process

Most of us are never going to be effective therapists across a range of different therapy approaches But: We can do a better job of listening to and learning from each other within the PCE tradition: Classical, nondirective therapists Broadly relational person-centred therapists Focusers and EFT therapists Person-centred-based pluralistic experimenters in other approaches Near neighbors in 4th generation CBT (eg Schema therapy) and contemporary relational psychodynamic therapy

Here in the Counselling Unit, I have found myself fascinated by rigorous nondirectivity in therapy Personally, I could never adopt a sustained, rigorously nondirective stance Nevertheless, it is clear to me that there are clients and moments when this is absolutely the best thing to do I want to know: What are these moments? (=client markers) How can I maintain nondirectivity at these moments? (=therapist processes) What are the immediate and ongoing effects of these moments? (=micro-outcomes)

It’s so difficult to live in the middle: Between dichotomies/unresolved differences/ ambiguity/ complexity David Rennie’s “The rocky middle road” However, I strongly suspect: Nondirectivity and Process Guiding might actually need each other Can be a source of moderation and creativity for each other My dream for the next 20 years of the CU: That as a community, we learn how to effectively live with and grow from from the creative tension between Nondirectivity and Process Guiding

Those questions I asked five years when I walked into this place… About doing meaningful work, being accepted, finding space, changing things, and being changed… The Answer is … Yes Blog: